GPEI-The future of public health depends on women.

With the polio vaccine, new-born children have a better chance of a healthy life © WHO/Chad

Therese and Léonie reminded me of this hard truth in a recent visit to a hospital in N’Djaména, Chad. One is a newborn girl and the other is a veteran of the campaign to eradicate a human disease for only the second time in history –polio-.

As a Gender Champion for Polio Eradication, I have committed to supporting the global initiative to eradicate polio and the women who work tirelessly to protect children from lifelong paralysis. During my visit to Chad, I had the honour of giving two drops of life-saving oral polio vaccine to two newborns.

Protected from a disease which once struck millions of children, Therese now has a better chance of a healthy life. Thanks to the Global Polio Eradication Initiative (GPEI) – spearheaded by Rotary International, national governments, the World Health Organization, UNICEF, CDC, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance – she is one of more than 2.5 billion children who have received the oral polio vaccine, as the global polio caseload has been reduced by 99% since 1988.

But as I looked at Therese, I also wished that she would have a better chance not just for health, but also for opportunities to prosper. I thought of a recent WHO report I had read – Delivered by Women, Led by Men – which observed that women make up 70% of the global health workforce but hold only 25% of senior roles – a situation that is no different for the polio program. Would Therese’s future reflect that disparity?

Administering the polio vaccine to Therese © WHO/Chad

I found both frustration and hope in answer to my question when I listened to Ms. Léonie Ngaordoum, the woman responsible for the campaign which brought the vaccine to Therese.

Léonie is head of vaccine operations for Chad’s immunization programme. It is women like her who have brought us this far in the long fight against polio. It is women like her who have gone the extra mile to keep their countries safe when, in 2020, the polio programme faced unprecedented challenges in the face of a new pandemic- COVID-19.

Her journey to a senior public health position in Chad has been difficult. Driven to remote areas on dangerous roads to oversee vaccination campaigns, she has twice suffered accidents, one of which left her with severe spinal injuries. She has faced gender discrimination, countered vaccine misinformation, convinced vaccine sceptics, and stayed the course despite the severe strain of COVID-19, and struggling for respect and recognition in a male-dominated environment.

Today she has a clear vision to share: “I speak about vaccination as if it were a vocation…the program change needed to achieve polio eradication is to empower enough women.” Léonie’s experience highlights the necessity of increasing senior roles among women in the health workforce and involving them in policy decisions.

Women like her frequently operate in dangerous and conflict-affected areas, putting their own personal safety at risk – all in efforts to protect communities from deadly diseases. Women have a greater level of trust with other women and thus are able to enter households and have interactions with mothers and children necessary to deliver the polio vaccine. And this way they can also provide other services, such as health education, antenatal care, routine immunization, and maternal health.

Ms. Léonie Ngaordoum (second from the right) is the head of vaccine operations for Chad’s immunization programme © WHO/Chad

The knowledge and skills gained by this workforce are already being deployed against COVID-19, in surveillance, contact tracing, and raising public awareness. Indeed, more than 50 percent of the time spent by GPEI health workers is already dedicated to diseases and threats beyond polio. It’s clear that the future of public health is inextricably linked to the status of women. Their heroic actions provide nothing less than a blueprint for the future of disease prevention. The Resolution on “Women, girls and the response to COVID-19”, adopted last year by the UN General Assembly, should play a key role when addressing these challenges and the specific needs of women and girls in conflict situations.

The centrality of women to the success of public health projects has for too long gone unrecognised, and must be formalized. That is why today, on International Women’s Day, we must pay tribute to the tremendous contribution of women like Léonie around the world in protecting their communities from deadly diseases such as polio. But at the same time, thinking of the world in which Therese will come of age, we need to commit to empower every woman and girl. It will not only make for a more just world – but a healthier one too.

Heather meeting an all-women vaccinator team in Lao PDR. Over the last few years, she has played a crucial role encouraging members of the polio programme to “put on their gender glasses”. © Heather Monnet

Throughout her career as a Resource Mobilization Officer for WHO’s polio eradication programme, Heather Monnet has held onto her vision of a polio-free world. A respected communicator with a deep understanding of the polio programme, she was one of the first in the programme to realize that considering gender is crucial to defeat the poliovirus. Since 2017, she has successfully “led from behind”, supporting the Global Polio Eradication Initiative (GPEI) to develop a gender strategy and workstream which has become a model for other United Nations programmes, and which is designed to overcome some of the most intractable challenges facing polio eradicators.

Describing her motivation, Heather describes “putting on her gender glasses”. She explains, “We had reached a point where it seemed like we had turned nearly every stone to eradicate polio, and yet we had not defeated the disease. At the same time, the introduction of the sustainable development goals had led to an increasing awareness of gender. I began to think more about how gender affects health and health-seeking behaviors.”

“I was not, and am still not a gender expert, but as Member States began to speak more about this issue, it was increasingly on my radar. Putting on my “gender glasses”, I realized that gender was an unexplored intersection for polio eradication, and it could be transformative for our work.”

The case for considering gender

Heather holding a Rotary EndPolio bear, sold by UK Rotarians to raise money for polio eradication. © Heather Monnet

In polio eradication, areas where gender intersects with health delivery include exploring whether boys and girls are equally as likely to receive the polio vaccine, and if gender norms impact whether mothers are able to take their children to health centres for routine immunization.

In some places, such as in Nigeria, women are often more effective at delivering the polio vaccine than men, as it is more culturally acceptable for them to interact with mothers and enter homes to vaccinate the smallest children. The GPEI Gender Technical Brief showed how the presence of female health workers in Pakistan has been associated with substantial increases in tetanus vaccine coverage, attended births, and full immunization coverage of children.

To explore and respond to the gender dynamics of polio eradication, the GPEI has published a comprehensive gender equality strategy. A dedicated gender analyst works in the polio programme at WHO headquarters, and gender focal points have been appointed at regional levels and in some country offices. Data is now routinely disaggregated by sex, and there has been a concerted effort to use gender analyses to inform programme policy. The team are currently engaged in implementing the GPEI gender strategy as well as supporting efforts to mainstream gender across WHO, including through a dedicated gender data working group.

Advocating for consideration of gender within the programme has not always been easy. Heather explains, “The polio programme is huge and so many people are involved. Encouraging people to put on their ‘gender glasses’ even for five minutes can be a challenge. But what is really encouraging is that once we educate people about how gender impacts their work, they often have an “aha” moment.”

“The next and crucial steps are striving to ensure that the gender strategy is implemented. This requires all those involved in polio to be engaged – whether it’s designing a gender-inclusive microplan, collecting sex-disaggregated data during a campaign, or considering how gender impacts the way we pay vaccinators. As we integrate gender into our work, we also need to identify the building blocks to ensure that this workstream is sustainably mainstreamed. This is not dependent on one person – rather it takes everyone having exposure.”

Polio Gender Champions

The GPEI gender workstream is supported by Polio Gender Champions, who work to raise the voices of those engaged in the programme. Champions include Senator Hon Marise Payne, Australian Minister for Foreign Affairs and Minister for Women, Wendy Morton, Minister of European Neighbourhood and the Americas at the Foreign, Commonwealth & Development Office in the United Kingdom, and Arancha González Laya, who is the Spanish Minister for Foreign Affairs, European Union and Cooperation.

Heather explains that the vision and leadership of the gender champions is crucial for achieving change. “The gender champions amplify the voices of those who don’t have a megaphone on the global stage and whose voices need to be heard. For instance, female frontline workers have a lot to say, but their voices aren’t always listened to. Our gender champions raise up these voices from the field.”

The GPEI Gender Strategy outlines key intersections between gender and polio eradication and sets out a framework for mainstreaming gender into the programme. © WHO Afghanistan/Roya Haidari

“This feeds into our attempts to improve the way that health is delivered. We know that most healthcare is delivered by women, but the systems to deliver it are designed by men. Practical steps to support women employed by the programme may include ensuring that polio vaccination training materials can be understood by individuals with lower literacy, and ensuring that there are safe, private bathrooms available for women to use during long campaign days. When we plan routes to deliver vaccines from house to house, we should consider that women might prefer to take a different route which gives them a greater feeling of personal security. Women may not feel comfortable speaking about these issues to a male supervisor, so we must also ensure that enough female supervisors are recruited and trained. Gender champions are key to keeping these issues high on the global agenda.”

Over the last few years, the GPEI’s gender work has been recognized in multiple high-level forums, and is leading the way for other programmes. Heather identifies two moments when she felt particularly proud – when the Polio Oversight Board adopted and endorsed the GPEI gender strategy, and at a high-level meeting hosted by the Government of the United Arab Emirates in advance of the Reaching the Last Mile Forum in November 2019, during which the Canadian representative described GPEI’s gender strategy as one of the strongest in global health and noted that it should stand as an example for others.

Heather explains, “I have been inspired by what we have achieved – we have planted the seeds and the soil is now being nourished. Our work on gender is growing into something amazing – and the world is watching what it will become.”

PN: President Knaack, thank you for taking the time to speak to us. A little more than a year into the global COVID-19 pandemic, what is your take on the current situation, also with a view of the global effort to eradicate polio?

Holger Knaack, 2020-2021 Rotary International president. © Rotary International

HK: There are many interesting lessons we learned over the past 12 months. The first is the value of strong health systems, which perhaps in countries like mine – Germany – we have over the past decades taken for granted. But we have seen how important strong health systems are to a functional society, and how fragile that society is if those systems are at risk of collapse. In terms of PolioPlus, of course, the reality is that it is precisely children who live in areas with poor health systems who are most at risk of contracting diseases such as polio. So everything must be done to strengthen health systems systematically, everywhere, to help prevent any disease.

The second lesson is the value of scientific knowledge. COVID-19 is of course a new pathogen affecting the world, and there remain many unanswered questions. How does it really transmit? Who and where are the primary transmittors? How significant and widespread are asymptomatic (meaning undetected) infections and what role do they play in the pandemic? And most importantly, how best to protect our populations, with a minimum impact on everyday life? These are precisely the same questions that were posed about polio in the 1950s. People felt the same fear back then about polio, as we do now about COVID. Polio would indiscriminately hit communities, seemingly without rhyme or reason. Parents would send their children to school in the morning, and they would be stricken by polio later that same day. Lack of knowledge is what is so terrifying about the COVID-19 pandemic. It also means we are to a large degree unable to really target strategies in the most effective way. What polio has shown us is the true value of scientific knowledge. We know how polio transmits, where it is circulating, who is most at risk, and most importantly, we have the tools and the knowledge to protect our populations. This knowledge enables us to target our eradication strategies in the most effective manner, and the result is that the disease has been beaten back over the past few decades to just two endemic countries worldwide. Most recently, Africa was certified as free of all wild polioviruses, a tremendous achievement which could not have been possible without scientific knowledge guiding us. So while we grapple for answers with COVID, for polio eradication, we must now focus entirely on operational implementation. If we optimize implementation, success will follow.

And the third lesson is perhaps the most important: we cannot indefinitely sustain the effort to eradicate polio. We have been on the ‘final stretch’ for several years now. Tantalizingly close to global eradication, but still falling one percent short. In 2020, we saw tremendous disruptions to our operations due to COVID-19. We never know when the next COVID-19 will come along, to again disrupt everything. Last year, the polio program came away with a very serious black eye, so to speak. But we have the opportunity to come back stronger. We must now capitalize on it. We know what we need to do to finish polio. We must now finish the job. We must all recommit and redouble our efforts. If we do that, we will give the world one less infectious disease to worry about once and for all.

During the COVID-19 pandemic, members of the Rotary Club of Boa Vista-Cacari (D4720) deliver bleach to a shelter for Venezuelan refugees in Boa Vista, Roraima, Brazil. © Rotary International

PN: You recently called on the Rotary network worldwide to use its experiences from PolioPlus in supporting the COVID-19 response. Could you elaborate on that?

HK: We have a global network of more than 1.2 million volunteers worldwide. This network has been consistently and systematically utilized to help engage everyone from heads of state to mothers in the most remote areas of rural India for polio eradication. We have helped secure vaccine supply and distribution, and increased trust in vaccines among communities. In the process, we have learned many lessons on what it takes to address a public health threat and these same lessons now should be applied to the COVID-19 response, especially as vaccines are now starting to be rolled out. That is why I thought it was important to call on our membership network to use their experiences and apply it to the COVID-19 response.

PN: What has been the reaction so far?

HK: Overwhelmingly supportive, I would say. As an example, in Germany, Switzerland, Liechtenstein, Austria and other countries in Europe, Rotarians are encouraging active participation of the provided vaccination service. And because COVID vaccination is provided free of charge, vaccinated individuals are encouraged to instead donate the cost of what this vaccine would have cost them – approximately US$25 – to PolioPlus. This has a dual benefit: they are protected from COVID and contributing to the global response, and they are ensuring children are also protected against polio, critically important now as the COVID-pandemic has significantly disrupted health services and an estimated more than 80 million children worldwide are at increased risk of diseases such as polio.

During the COVID-19 pandemic, members of Rotary and Rotaract clubs in D3281 (Bangladesh) package and distribute 10,000 bottles of hand sanitizer to underserved people in the cities of Dhaka, Dinajpur, Khulna, Rajshahi, and Rangpur in Bagladesh. © Rotary International

PN: And from what we understand, the Rotary PolioPlus network of National PolioPlus Committees has in any event been supporting global pandemic response over the past 12 months already, is that correct?

HK: The ‘Plus’ in PolioPlus has always stood for the fact that we are eradicating polio, but doing it in such a way that we are in fact doing much more, by supporting broader public health efforts. I’m extremely proud that Rotary and Rotarians around the world have helped bring the world to the threshold of being wild polio-free. But I’m perhaps even more proud of the ‘plus’ – or ‘added’ value – that this network has provided in the process. Things that are largely unseen, but which are very evident and concrete. So indeed, Rotarians have been actively engaged in the pandemic response, particularly in high-risk areas such as Pakistan, and Nigeria. We have supported contact tracing, educated communities on hygiene and distancing measures, supporting testing and other tactics. We have a unique set of experiences, and more importantly a unique infrastructure and network, to help during such crises. It’s morally the only way to operate. And actually, it is operationally beneficial also to polio eradication, as we are engaging with communities on broader terms, and not just on polio.

PN: Thank you again for taking the time to speak with us. Do you have any final thoughts or reflections for our readers?

HK: If we did not know it before, we certainly know now how quickly and dangerously infectious diseases spread around the globe. Polio is no different, and we know that it will not stay confined to Pakistan and Afghanistan if we don’t stop transmission there as soon as possible. We know that given the chance, this disease will come roaring back, and within ten years, we would again see 200,000 children paralysed every single year, all over the world. Perhaps even in my country, Germany. That would be a humanitarian catastrophe that must be averted at all costs.

During the COVID-19 pandemic, members of Rotary clubs in D9212 in Kenya established an emergency support team to distribute water stations to communities and informal settlements across the country for sanitary handwashing and other needs. © Rotary International

The good news is that it can be averted. We know what it takes. Pakistan and Afghanistan are re-launching their national eradication efforts in an intensified, emergency manner, following a disrupted 2020. This is encouraging to see. Mirroring this engagement must be the strengthened commitments by the international development community. We must ensure that the financial resources are urgently mobilised to finish polio once and for all. I am particularly proud that my own government, Germany, for example, has just recently committed an additional 35 million EURO to the effort, along with an additional 10 million EURO for efforts in Nigeria and Pakistan. Such support is particularly critical now, given that more than 80 million children are at heightened risk of diseases such a polio due to COVID-19 disruptions, and late last year, UNICEF and WHO issued an emergency call for action to urgently address this. And as we have seen, by supporting polio eradication, donors effectively get twice as much for their contribution: they help contribute to polio eradication, but also by doing so help contribute to the polio network’s support to public health emergencies such as COVID-19.

In short, we have it in our own hands to achieve success. There are no technical or biological reasons why polio should persist anywhere in the world. It is now a question of political and societal will. If we all redouble our efforts, success will follow.

Please consider making a contribution to Rotary’s PolioPlus fund, and have your donation matched 2-to-1 by the Bill & Melinda Gates Foundation.

148th session of the WHO Executive Board in Geneva, Switzerland. ©WHO / Christopher Black

Meeting virtually at this week’s WHO Executive Board (EB), global health leaders and ministers of health urged for concerted and emergency efforts to finally rid the world of polio, noting a global and collective responsibility to finish the disease once and for all. Delegates also reiterated their support for the sustainable transitioning of polio assets, recognizing that successful polio transition and polio eradication are twin goals.

Noting that endemic wild poliovirus is now restricted to just two countries – the lowest number in history – with the African region being certified as wild polio-free in August 2020, delegates urged intensified efforts to wipe out the remaining chains of transmission of this strain and prevent global resurgence. The representatives of both Pakistan and Afghanistan demonstrated strong commitments to this goal and urged collective responsibility to achieve success. Delegates also expressed strong appreciation for the establishment of the Eastern Mediterranean Ministerial Regional Subcommittee on Polio Eradication and Outbreaks, by WHO Regional Director Dr Ahmed Al-Mandhari, which focuses on critical barriers to overcome to achieve zero poliovirus.

The EB urged all stakeholders to follow WHO and UNICEF’s joint emergency call to action, launched 6 November 2020, including by prioritising polio in national budgets as they rebuild their immunization programmes in the wake of COVID-19, and urgently mobilising additional resources for polio emergency outbreak response. To address the increasing global health emergency associated with circulating vaccine-derived poliovirus (cVDPV) outbreaks, delegates expressed appreciation of new strategic approaches, including the roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation OPV aimed at more effectively and sustainably addressing these outbreaks. This vaccine, which was recently granted a WHO Emergency Use Listing recommendation, is anticipated to be initially rolled-out in the first quarter of 2021. The GPEI is working with countries affected and at high risk of cVDPV2 to prepare for possible use of the vaccine.

Amid the new COVID-19 reality, the EB also expressed deep appreciation for the GPEI’s ongoing support to COVID-19 response. In December 2020, the heads of the GPEI core partners at their final Polio Oversight Board (POB) meeting of the year, confirmed that the polio infrastructure will continue to provide such support, including to the COVID-19 vaccine roll-out.

Member States additionally reiterated their support of polio transition, emphasising the need to ensure sustained, robust public health programming. Several EB members urged for strengthening the links built between the polio, immunization and emergencies programmes during COVID-19 response in the next phase of the pandemic, including for the effective rollout of the COVID-19 vaccine.

Children waiting at a polio vaccination campaign in Al-Mualla district, Yemen. ©WHO/EMRO

Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, commented, “We share the understanding that polio eradication and transition are equally important targets: as we work towards eradication we must think about the future. This is how we will ensure that health systems retain capacity and are strengthened long after polio is ended.”

WHO’s Deputy Director-General, Dr Zsuzsanna Jakab, noted the increasing cross-programmatic integration between polio and other public health programmes, including the introduction of integrated public health teams in countries prioritized for polio transition, bringing together polio, emergencies and immunization expertise. The Regional Director for the African Region, Dr Matshidiso Moeti, emphasised that the work of polio personnel to support the pandemic response, “highlight[s]… the importance of working in interconnected ways going forward.” Dr Al-Mandhari, addressing the delegates, said: “Polio continues to be a public health emergency of international concern. Now is the time to be shoring up the polio programme and mobilizing funding, including domestic funds, so that this remarkable public health and pandemic response mechanism can remain robust and can be integrated into broader public health services across the region. Now is the time for full regional solidarity and mobilization.”

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked global health leaders for their continued dedication to polio eradication and public health, sentiments echoed by several other partners, including the United Nations Foundation (UNF). UNF expressed concern about the drop in population immunity, especially for polio and measles, declared support for the joint emergency call to action to prioritize investments for preventing and responding to polio and measles outbreaks, and urged continued focus on strengthening immunization programmes.

The EB discussion will also help inform the finalization of the new strategic plan. This strengthened strategic plan – being developed in broad consultation with partners, stakeholders and countries – is based on best practices and lessons learned, and focuses on fully implementing approaches proven to work. It is expected to be presented to the World Health Assembly in May.

“If we did not know it before, we certainly know now how quickly infectious diseases can spread across the world and wild polio is one such infectious disease. Unlike with COVID-19, where many medical and scientific questions remain unanswered, we know precisely what it takes to stop polio,” said Aidan O’Leary, newly-appointed Director of the Global Polio Eradication Initiative at WHO. “We know how polio transmits, who is primarily at risk and we have all the tools and approaches needed to stop it. That is what this strengthened strategic plan is all about – to bring all the solutions together into a single roadmap to achieve success and through focusing on more effective implementation. What discussions at the EB this week clearly displayed is a strong global sense of commitment and solidarity to do just that: better implementation of what we know works. Together, if we do that, success will follow and we will be able to give the world one less infectious disease to worry about, once and for all.”

Speaking more broadly on global public health issues, the EB welcomed confirmation by the United States of its intention to remain a member of WHO. In a statement by the United States, the country underscored WHO’s critical role in the world’s fight against COVID-19 and countless other threats to global health and health security, confirming it would continue to be a full participant and global leader in confronting such threats and advancing global health and health security.

O’Leary took over as Director for Polio Eradication at WHO on 1 January 2021, from Michel Zaffran, who will enter a well-deserved retirement end-February. O’Leary brings with him a vast array of experience in both polio eradication and emergencies, including through the United Nations Office for the Coordination of Humanitarian Affairs (OCHA).

Outgoing Director Michel Zaffran (L) and Aidan O’Leary (R) ©WHO/Katerina Alves

PN: Aidan, Michel, thank you both for taking the time to speak with us today. Aidan – you are taking over from Michel as Director for Polio Eradication at WHO. Polio is 99% eradicated globally, but it has been at 99% for many years. Ultimately, your job will be to achieve that elusive 100%. Do you find the task ahead daunting?

A-O’L: I’m not sure ‘daunting’ is the adjective I would use. But ‘challenging’ for sure. As you say, we have been at 99% for many years now. We have reduced the incidence of polio from 350,000 children paralysed every year in 1988, to less than 1,000 in 2020. But that is not enough, not if we are trying to eradicate a disease. Polio is a highly-infectious disease, and if we did not know it before COVID-19, we certainly know now how quickly infectious diseases can spread globally. If we do not eradicate polio, this virus will resurge globally.

PN: As new Director, what will be your priorities?

A-O’L: My priority, and all of our priorities, must be simply this: find and vaccinate every last child. If we do that, poliovirus will have nowhere to hide. That means in the first instance finding out where those last remaining unreached children are, and what obstacles stand in the way to vaccinating them. Is it because of lack of infrastructure? Insecurity or inaccessibility? Lack of proper operational planning? Population movements? Resistance? Gender-related barriers? If we can identify the underlying reasons, we can adapt our operations and really zero in on those last remaining virus strains.

Amna showing her marked finger after receiving the life-saving polio vaccine in Karachi, Pakistan – one of the two remaining endemic countries.© WHO/EMRO

PN: Michel, you have led this effort for the past five years, and during that time have guided the effort to restrict wild poliovirus transmission to just Pakistan and Afghanistan. You have overseen the achievement of a wild polio-free Africa, an incredible achievement. However, this time has also seen an increase in emergence of circulating vaccine-derived poliovirus, or cVDPV, outbreaks. How do you see the priorities going forward?

MZ: The goal of this effort is of course to ensure that no child will ever again be paralysed by any poliovirus, be it wild or vaccine-derived. This we have to achieve in phases. First, we have to interrupt all remaining wild poliovirus strains, before we can then ultimately stop use of oral polio vaccine, or OPV for short, in order to eliminate the long-term risks of cVDPVs. Aidan has tremendous experience, in both remaining wild poliovirus endemic countries, having led the OCHA office in Afghanistan and having been Chief of Polio Eradication in Pakistan for UNICEF. So he knows the challenges and realities involved. Eradicating the last remaining strains of wild poliovirus must be the overriding priority – success ultimately hinges on that.

At the same time, we have new strategies, tools and approaches to address the increasing cVDPV emergency, notably the novel OPV type 2, or nOPV2 for short, to more effectively and sustainably stop such strains. Ultimately, though, we need to reach children. Only vaccinations save lives, not vaccines.

A-O’L: Michel just mentioned an important word: emergency. And that is precisely what we are facing with polio, whether it’s wild or vaccine-derived. I believe my experience working in emergency settings can help us achieve our goal, including by linking polio operations more closely to other emergency efforts. That is also one of the reasons why WHO and UNICEF recently jointly issued an emergency call for action on polio and measles, and we hope all stakeholders will respond accordingly.

MZ: I would echo that. Particularly in a post-COVID world, the programme must also continue to adapt its approaches and operations, and no longer work so much in isolation. We have to integrate with other efforts including emergency response and broader routine immunization efforts.

A-O’L: I would just add that Michel is really leaving me with a solid base to operate from. He and his teams across the GPEI partnership have built up such a strong infrastructure. I’m thinking here for example of the gender equality work of the programme – it has really been trail-blazing and I know other health and development efforts are looking to our experience on this. It’s a great opportunity to further leverage and expand collaboration with others. So we’ve really become a global leader in many new ways of working, and ultimately, that can only mean more support for this effort.

PN: Thank you so much for speaking with us today. Could we ask for final thoughts from both of you?

A-O’L: We have many challenges, but if any network can achieve success, it is the GPEI network. Our greatest strength that we have is partnerships. Starting with Rotary International and Rotarians worldwide who are tirelessly working towards success, to our other partners including at my old organization UNICEF and our newest partner Gavi who is helping to integrate the programme, and of course ultimately to donor and country governments and communities: this is where our strength and power lies. If we harness this partnership effectively, if we all work together, then we will reach that last remaining child, and we will ensure that this disease is eradicated once and for all.

MZ: For me it has been an absolute honour and privilege to lead this effort for the past years, and I leave with a sense of real optimism. I believe Aidan is the right person for this job right now. In November, at the World Health Assembly, we saw tremendous support for polio eradication from Member States. We have new tools, such as nOPV2, and tremendous new commitments. We are working on a new strategy, to lead us to success. But ultimately, all comes down now to implementation. 2020, the COVID year, taught us many lessons. Many of the questions that are still being asked about COVID – how does it transmit, where is it primarily circulating, what are the best tools and strategies to stop it – have been answered for polio. We know what the virus is doing, how it is behaving, and who it is affecting. Most importantly, we know what we have to do to stop it, and we have all the tools to stop it. But what 2020 also taught us is that this cannot last forever. We never know when a next COVID emergency comes along, which will disrupt everything. In polio eradication, we are being given another chance in 2021, after a bruising 2020. We have to capitalize on it. We have to focus everything on implementation. If we do that, success will follow.

Syed Razzaq, technical officer for MIS/IT information management team lead shows data on Pakistan’s COVID-19 response at the operations room at National Emergency Operation Centre (NEOC) for Polio Eradication, located inside the National Institute of Health. © WHO/EMRO

In a newly-released statement following the final meeting of the Polio Oversight Board (POB) that was held virtually on 18 December 2020, the POB looks back at the support that the programme provided to respond to the COVID-19 pandemic, while remaining strongly devoted to the goal of a polio-free world. The POB reaffirms its commitment that polio-funded assets are available to countries to respond to the COVID-19 pandemic, especially in the next phase of COVID-19 vaccine introduction and delivery.

The POB also believes that for countries introducing COVID-19 vaccine, there are lessons and experiences to be learnt from the rollout of nOPV2 under the EUL recommendation, if emergency regulatory pathways such as WHO EUL are used, including in the areas of monitoring readiness-verification, safety surveillance, and regulatory considerations.

Download the statement.

A vaccinator administering polio vaccine to a child during a vaccination campaign in Yemen, July 2020. ©WHO/EMRO

The COVID-19 pandemic has brought the need for strong health systems and global health security into sharp focus. Last week, the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO) agreed a £30 million increase in the first payment to the World Health Organization of their 2019 – 2023 pledge, meaning that the total amount released for polio eradication activities is £70 million. Coming amidst challenges posed by the COVID-19 pandemic, including a growing immunity gap, this gesture is a testament to the UK government’s strong commitment to investing in high impact programmes that strengthen global health security – including the polio programme.

Throughout the COVID-19 pandemic, the Global Polio Eradication Initiative (GPEI) has played an integral role in the global response, contributing physical assets, outbreak response expertise and a trained workforce to slow the spread of the novel coronavirus. This support was largely made possible thank to donors like the United Kingdom.

The United Kingdom is a historic donor to efforts to end polio, committing an exceptional £400 million to eradication activities in the period from 2019 – 2023. Since 1985, the UK has contributed over US $1.6 billion, and has played an integral role in preventing the paralysis of more than 18 million children.

Widespread polio vaccination efforts over the past 30 years have led to a 99.9% decrease in global polio cases. Health workers, local governments, global partners and generous donors have made this progress possible. The increased payment by the UK will ensure that this progress against polio is not lost due to disruptions by the COVID-19 pandemic, and that the polio programme can continue to play an essential role in supporting pandemic response efforts around the world.

As the U.K. prepares to host the upcoming G7 meeting, the GPEI is hopeful that issues around global health security and health systems strengthening, to which polio can contribute, will be prioritized.

Aidan O’Leary (left) during a field visit.

Mr Aidan O’Leary has been officially appointed as the new Director for Polio Eradication at the World Health Organization, with effect from 1 January 2021. O’Leary is taking over from Michel Zaffran, who will enter retirement end-February.

O’Leary brings with him a wealth of emergencies and public health experience. Originally from Ireland, he is currently Head of Office in Yemen for the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), in addition to having extensive experience in emergency settings such as Iraq and Syria, where he also served as Head of Office for OCHA.

O’Leary also has strong experience of working on polio eradication in the remaining wild poliovirus endemic countries. He was Chief of Polio Eradication in Pakistan for UNICEF from 2015-2017 and Head of Office for OCHA in Afghanistan from 2011-2014.

Aidan O’Leary

“I’m excited to join this incredible programme,” commented O’Leary on his appointment. “COVID-19 led to a tough year for polio eradication in 2020, but we have adapted our strategies and I believe this programme has a real opportunity to reboost our efforts in 2021. I’ve been so impressed by how this programme has taken on challenges and continues to innovate, and all of it rooted in its strong partnership. I look forward to working with all partners, including my old organization UNICEF, and of course Rotarians from around the world.”

“With this appointment, I am able to enter my retirement with a sense of reassurance,” said Michel Zaffran. “He is the right person for the job at this time, given his set of experiences both in the polio programme and emergencies, and in particular in Pakistan and Afghanistan. I am confident his leadership will help drive this programme to ultimate success.”

O’Leary joins the GPEI in 2021, and will focus on capitalizing on new commitments displayed at the World Health Assembly in November, the introduction of new tools and innovations such as novel oral polio vaccine type 2 (nOPV2), and an optimization of new governance and strategy structures currently being developed across the partnership.

The GPEI welcomes Aidan O’Leary to the GPEI family.

The Executive Board Room at WHO Headquarters during the first ever virtually-held World Health Assembly. © WHO/C. Black

In a year marked by the global COVID-19 pandemic, global health leaders convening virtually at this week’s World Health Assembly called for continued urgent action on polio eradication. The Assembly congratulated the African region on reaching the public health milestone of certification as wild polio free, but highlighted the importance of global solidarity to achieve the goal of global eradication and certification.

Member States, including from polio-affected and high-risk countries, underscored the damage COVID-19 has caused to immunization systems around the world, leaving children at much more risk of preventable diseases such as polio. Delegates urged all stakeholders to follow WHO and UNICEF’s joint call for emergency action launched on 6 November to prioritise polio in national budgets as they rebuild their immunization systems in the wake of COVID-19, and the need to urgently mobilise an additional US$ 400 million for polio for emergency outbreak response over the next 14 months. In particular, Turkey and Vietnam have already responded to the call, mobilising additional resources and commitments to the effort.

The Assembly expressed appreciation at the GPEI’s ongoing and strategic efforts to maintain the programme amidst the ‘new reality’, in particular the support the polio infrastructure provides to COVID-19-response efforts. Many interventions underscored the critical role that polio staff and assets play in public health globally and underline the urgency of integrating these assets into the wider public health infrastructure.

At the same time, the GPEI’s work on gender was recognized, with thanks to the Foreign Ministers of Australia, Spain and the UK for their roles as Gender Champions for polio eradication.

Delegates expressed concern at the increase in circulating vaccine-derived poliovirus (cVDPV) outbreaks, and urged rapid roll-out of novel oral polio vaccine type 2 (nOPV2), a next-generation oral polio vaccine aimed at more effectively and sustainably addressing these outbreaks. This vaccine is anticipated to be initially rolled-out by January 2021.

Speaking on behalf of children worldwide, Rotary International – the civil society arm of the GPEI partnership – thanked the global health leaders for their continued dedication to polio eradication and public health, and appealed for intensified global action to address immunization coverage gaps, by prioritizing investment in robust immunization systems to prevent deadly and debilitating diseases such as polio and measles.

GENEVA/ NEW YORK, 6 November 2020 – UNICEF and the World Health Organization (WHO) today issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases.

The two organizations estimate that US$655 million (US$400 million for polio and US$255 million for measles) are needed to address dangerous immunity gaps in non-Gavi eligible countries and target age groups.

“COVID-19 has had a devastating effect on health services and in particular immunization services, worldwide,” commented Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But unlike with COVID, we have the tools and knowledge to stop diseases such as polio and measles. What we need are the resources and commitments to put these tools and knowledge into action. If we do that, children’s lives will be saved.”

“We cannot allow the fight against one deadly disease to cause us to lose ground in the fight against other diseases,” said Henrietta Fore, UNICEF Executive Director. “Addressing the global COVID-19 pandemic is critical. However, other deadly diseases also threaten the lives of millions of children in some of the poorest areas of the world. That is why today we are urgently calling for global action from country leaders, donors and partners. We need additional financial resources to safely resume vaccination campaigns and prioritize immunization systems that are critical to protect children and avert other epidemics besides COVID-19.”

In recent years, there has been a global resurgence of measles with ongoing outbreaks in all parts of the world. Vaccination coverage gaps have been further exacerbated in 2020 by COVID-19. In 2019, measles climbed to the highest number of new infections in more than two decades. Annual measles mortality data for 2019 to be released next week will show the continued negative toll that sustained outbreaks are having in many countries around the world.

At the same time, poliovirus transmission is expected to increase in Pakistan and Afghanistan and in many under-immunized areas of Africa. Failure to eradicate polio now would lead to global resurgence of the disease, resulting in as many as 200,000 new cases annually, within 10 years.

New tools, including a next-generation novel oral polio vaccine and the forthcoming Measles Outbreak Strategic Response Plan are expected to be deployed over the coming months to help tackle these growing threats in a more effective and sustainable manner, and ultimately save lives. The Plan is a worldwide strategy to quickly and effectively prevent, detect and respond to measles outbreaks.

Notes to editors:

Download photos and broll on vaccinations, including polio and measles vaccinations here

Generous support from Gavi, the Vaccine Alliance, has enabled previous access to funding for outbreak response, preventive campaigns and routine immunization strengthening, including additional support for catch-up vaccination for children who were missed due to COVID-19 disruptions in Gavi-eligible countries. However, significant financing gaps remain in middle-income countries which are not Gavi-eligible. This call for emergency action will go to support those middle-income countries that are not eligible for support from Gavi.

About UNICEF

UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. For more information about UNICEF and its work for children, visit www.unicef.org. For more information about COVID-19, visit www.unicef.org/coronavirus. To know more about UNICEF’s work on immunization, visit https://www.unicef.org/immunization

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About the Global Polio Eradication Initiative

The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

About the Measles & Rubella Initiative

The Measles & Rubella Initiative (M&RI) is a partnership between the American Red Cross, the U.S. Centers for Disease Control and Prevention (CDC), UNICEF, the United Nations Foundation and the World Health Organization. Working with Gavi, the Vaccine Alliance, and other stakeholders, the Initiative is committed to achieving and maintaining a world without measles, rubella and congenital rubella syndrome. Since 2000, M&RI has helped deliver over 5.5 billion doses of measles vaccine to children worldwide and saved over 23 million lives by increasing vaccination coverage, responding to outbreaks, monitoring and evaluation, and supporting demand for vaccine.

Two female vaccinators in Borno, Nigeria, the last stronghold of the wild poliovirus in Africa. ©Andrew Esiebo/2020

Rotary’s 2020 World Polio Day Online Global Update programme on 24 October hails this year’s historic achievement in polio eradication: Africa being declared free of the wild poliovirus.

Paralympic medalist and TV presenter Ade Adepitan, who co-hosts this year’s programme, says that the eradication of wild polio in Africa was personal for him. “Since I was born in Nigeria, this achievement is close to my heart,” says Adepitan, a polio survivor who contracted the disease as a child. “I’ve been waiting for this day since I was young.”

He notes that, just a decade ago, three-quarters of all of the world’s polio cases caused by the wild virus were contracted in Africa. Now, more than a billion Africans are safe from the disease. “But we’re not done,” Adepitan cautions. “We’re in pursuit of an even greater triumph — a world without polio. And I can’t wait.”

Rotary Foundation Trustee Geeta Manek, who co-hosts the programme with Adepitan, says that World Polio Day is an opportunity for Rotary members to be motivated to “continue this fight.”

She adds, “Rotarians around the world are working tirelessly to support the global effort to end polio.”

Now that the World Health Organization (WHO) has declared that its African region is free of the wild poliovirus, five of the WHO’s six regions, representing more than 90 percent of the world’s population, are now free of the disease. It is still endemic in Afghanistan and Pakistan, both in the WHO’s Eastern Mediterranean region.

“This effort required incredible coordination and cooperation between governments, UN agencies, civil organizations, health workers, and parents,” says Manek, a member of the Rotary Club of Muthaiga, Kenya. “I’m proud of what we’ve accomplished.”

A child in Afghanistan receives a polio vaccine in a COVID-19 safe way. ©WHO/Afghanistan

A collective effort

Dr. Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee and a member of the Rotary Club of Lekki Phase 1, Lagos State, Nigeria, tells online viewers that the milestone couldn’t have been reached without the efforts of Rotary members and leaders in Africa and around the world.

Funsho, who was recently named one of TIME magazine’s 100 Most Influential People of 2020, says countless Rotarians helped by holding events to raise awareness and to raise funds or by working with governments to secure funding and other support for polio eradication.

“Polio eradication is truly a collective effort … This accomplishment belongs to all of us,” says Funsho.

Rotary and its members have contributed nearly $890 million toward polio eradication efforts in the African region. The funds have allowed Rotary to award PolioPlus grants to fund polio surveillance, transportation, awareness campaigns, and National Immunization Days.

This year’s World Polio Day Online Global Update is streamed on Facebook in several languages and in a number of time zones around the world. The programme, which is sponsored by the Bill & Melinda Gates Foundation, features Jeffrey Kluger, editor at large for TIME magazine; Mark Wright, TV news host and member of the Rotary Club of Seattle, Washington, USA; and Angélique Kidjo, a Grammy Award-winning singer who performs her song “M’Baamba.”

A child in Pakistan receives polio drops during the first campaign to resume in the country after vaccination activities were temporarily paused in the early stages of the COVID-19 pandemic. ©UNICEF/Pakistan

The challenges of 2020

It’s impossible to talk about 2020 without mentioning the coronavirus pandemic, which has killed more than a million people and devastated economies around the world.

In the programme, a panel of global health experts from Rotary’s partners in the Global Polio Eradication Initiative (GPEI) discuss how the infrastructure that Rotary and the GPEI have built to eradicate polio has helped communities tackle needs caused by the COVID-19 pandemic too.

“The infrastructure we built through polio in terms of how to engage communities, how to work with communities, how to rapidly teach communities to actually deliver health interventions, do disease surveillance, et cetera, has been an extremely important part of the effort to tackle so many other diseases,” says Dr. Bruce Aylward, Senior Adviser to the Director General at the WHO.

Panelists also include Dr. Christopher Elias, President of the Global Development Division of the Bill & Melinda Gates Foundation; Henrietta H. Fore, Executive Director of UNICEF; and Rebecca Martin, Director of the Center for Global Health at the U.S. Centers for Disease Control and Prevention.

Dr Samreen Khalil, a WHO Polio Eradication Officer, has pivoted her skillset to serve the COVID-19 response in Pakistan. She and thousands of her colleagues are on the frontlines fighting the pandemic and the poliovirus. ©WHO

Elias says that when there are global health emergencies, such as outbreaks of other contagious diseases, Rotarians always help. “They take whatever they’ve learned from doing successful polio campaigns that have reached all the children in the village, and they apply that to reaching them with yellow fever or measles vaccine.”

The programme discusses several pandemic response tactics that rely on polio eradication infrastructure: Polio surveillance teams in Ethiopia are reporting COVID-19 cases, and emergency operation centers in Afghanistan, Nigeria, and Pakistan that are usually used to fight polio are now also being used as coordination centers for COVID-19 response.

The online programme also includes a video of brave volunteer health workers immunizing children in the restive state of Borno, Nigeria, and profiles a community mobilizer in Afghanistan who works tirelessly to ensure that children are protected from polio.

Kluger speaks with several people, including three Rotary members, about their childhood experiences as “Polio Pioneers” — they were among more than a million children who took part in a huge trial of Jonas Salk’s polio vaccine in the 1950s.

A child is vaccinated against the poliovirus in Afghanistan. ©WHO/Afghanistan

The future of the fight against polio

Rotary’s challenge now is to eradicate the wild poliovirus in the two countries where the disease has never been stopped: Afghanistan and Pakistan. Routine immunizations must also be strengthened in Africa to keep the virus from returning there. The polio partnership is working to rid the world of all strains of poliovirus, so that no child is affected by polio paralysis ever again.

To eradicate polio, multiple high-quality immunization campaigns must be carried out each year in polio-affected and high-risk countries. During the COVID-19 pandemic, it is necessary to maintain populations’ immunity against polio while also protecting health workers from the coronavirus and making sure they don’t transmit it.

Rotary has contributed more than $2.1 billion to polio eradication since it launched the PolioPlus programme in 1985, and it’s committed to raising $50 million each year for polio eradication activities. Because of a 2-to-1 matching agreement with the Bill & Melinda Gates Foundation, each year, $150 million goes toward fulfilling Rotary’s promise to the children of the world: No child will ever again suffer the devastating effects of polio.

Consider making a donation to Rotary’s PolioPlus Fund in honor of World Polio Day.

Learn more.

Dr. Tunji Funsho, chair of Rotary’s Nigeria National PolioPlus Committee, joins 100 pioneers, artists, leaders, icons, and titans as one of TIME’s 100 Most Influential People. TIME announced its 2020 honorees during a 22 September television broadcast on ABC, recognizing Funsho for his instrumental leadership and work with Rotary members and partners to achieve the eradication of wild polio in the African region.

He is the first Rotary member to receive this honor for work toward eradicating polio.

A Rotarian for 35 years, Funsho is a member of the Rotary Club of Lekki, Nigeria, past governor of District 9110, and serves on Rotary’s International PolioPlus Committee. Funsho is a cardiologist and a fellow of the Royal College of Physicians of London. He lives in Lagos, Nigeria with his wife Aisha. They have four children; Habeeb, Kike, Abdullahi and Fatima; and five grandchildren.

TIME 100 comprises individuals whose leadership, talent, discoveries, and philanthropy have made a difference in the world. Past honorees include Bono, the Dalai Lama, Bill Gates, Nelson Mandela, Angela Merkel, Oprah Winfrey, and Malala Yousafzai.

Read more.

A young girl from Kano state, Nigeria, receiving the life-saving polio drops. © WHO

The WHO African Region is expected to be certified free of wild poliovirus on 25 August 2020. Chair of the WHO’s International Health Regulations Emergency Committee and of the AFRO Regional Immunization Technical Advisory Group Helen Rees explains the current cVDPV situation in Africa and its implications ahead of regional wild polio-free certification.

Q. Fifteen countries (as of 14 August 2020) in the World Health Organization’s African region have reported cases of circulating vaccine-derived polio type 2 (cVDPV2) in 2020. The total number of outbreak countries is 16. How does that impact the region’s upcoming wild polio-free certification?

First, it’s important to clarify that cVDPV is a different virus from the wild poliovirus, and will undergo a separate process to validate its absence once wild polio has been eradicated globally.

Second, I want to underscore that the ongoing cVDPV2 outbreaks in Africa do not affect the programme’s confidence that wild polio is gone from the region. Certification is backed by extensive data and a thorough evaluation process that demonstrates wild polio transmission has been interrupted on the continent.

In Africa, an independent body of experts called the African Regional Certification Commission for polio eradication (ARCC) oversees this process by carefully reviewing country documentation and analyzing the quality of surveillance systems and immunization coverage. With this intensive monitoring of polio programmes across the continent, the ARCC is able to confirm with 100% certainty that wild polio is gone from the region.

But for the ARCC, national polio programmes and GPEI partners, the work does not end here. Stopping cVDPVs remains an urgent priority. African countries will need to strengthen their efforts to reach all children with polio vaccines to protect them from cVDPVs and any importation of wild polio from the remaining endemic countries, Pakistan and Afghanistan.

How do cVDPV outbreaks happen? And why has the number of cVDPV cases in Africa increased more rapidly in the past couple years while wild cases have not?

cVDPVs can occur if not enough children receive the polio vaccine. In under-immunized populations, the live weakened virus in the oral polio vaccine (OPV) can pass between individuals and, over time, change to a form that can cause paralysis—resulting in cVDPV cases. This means that the cVDPV outbreaks we’re seeing today are revealing pockets across the continent where immunization rates are too low.

The reason for the increase in cases can be explained by low immunity to type 2 poliovirus, which causes the vast majority of cVDPV cases. This is in part due to a global vaccine switch that occurred in 2016, when countries stopped using the trivalent OPV (which protects against all three forms of polio) and replaced it with the bivalent OPV (which protects against just type 1 and 3).

The GPEI, following the advice of the Strategic Advisory Group of Experts, decided to make this vaccine switch based on extensive evidence that showed it would decrease the number of cVDPV outbreaks. However, immunity to type 2 poliovirus was lower than predicated at the time of the switch and so there were actually more cVDPV2 outbreaks. In response to the cVDPV2 outbreaks monovalent oral polio vaccine type 2 (mOPV2) has been used to interrupt transmission. But with increasing numbers of children who do not have type 2 immunity, mOPV2 vaccines have had to be used longer and in larger quantities than was initially anticipated. This larger and more extensive use of mOPV2 vaccines has seeded new outbreaks especially in areas of low immunization coverage and on the borders of outbreak response zones.

All this said, mOPV2 is an effective tool to stop cVDPV outbreaks if children are properly immunized.

If cVDPV outbreaks can only affect under-immunized communities, doesn’t the increasing number of outbreaks indicate that polio immunity levels are too low across the region? Why were countries able to stop wild polio then?

For years, the wild poliovirus has only existed in a small area on the continent. Nigeria reported its last case of paralysis due to wild polio four years ago, but most other countries haven’t seen a wild polio case in quite some time.

Across the continent, population immunity levels to type 1 polio (the only type of wild polio that remains in the world) and surveillance networks have continued to protect against any wild polio importation from remaining wild polio endemic countries.

However, the increasing number of cVDPV outbreaks across Africa is a reminder that countries cannot afford to let their guard down, and must continue reaching every child with the polio vaccine.

A young child receiving polio vaccination. ©WHO/Nigeria

What is the programme doing to address cVDPVs in Africa?

The same tactics that stop wild polio can be used to stop cVDPVs – high vaccination coverage and strong surveillance. The polio programme in Africa has proven experience and strategies to address cVDPV outbreaks. But we know that we cannot rely only on existing tactics, which is why the programme is innovating and adapting its strategies to address the challenge of cVDPVs specifically.

In early 2020, the GPEI released a comprehensive new strategy to stop cVDPV outbreaks currently affecting countries in Africa, Asia and the Middle East.

This includes revising outbreak response standard operating procedures to improve response time, doubling the size of the African Rapid Response Team, forming a global Rapid Response Team and prioritizing the GPEI’s ground presence in high-risk areas.

To raise immunization coverage, the GPEI partners – including Gavi, the Vaccine Alliance – are working to build and strengthen immunization systems in at-risk countries and expand routine immunization with the inactivated polio vaccine (IPV).

The strategy also includes the development of an additional tool to help stop cVDPV2 outbreaks – novel oral polio vaccine type 2 (nOPV2). nOPV2 is a modified version of the existing mOPV2 used to respond to cVDPV2 outbreaks that is less likely to change to a form that can cause paralysis.

The GPEI is confident that with strengthened commitment from country governments and full implementation of the tactics laid out in its strategy, cVDPVs can be wiped out across Africa.

Has COVID-19 affected the programme’s ability to stop cVDPV outbreaks in the region?

The recent pause in house-to-house polio campaigns to help control the spread of COVID-19 is expected to increase cVDPV transmission across affected countries.

The GPEI is taking a number of steps to get back on track. Even while campaigns were paused, surveillance activities continued so that as immunization activities ramp up the programme can target campaigns in areas that are most at risk.

The GPEI recently recommended that all countries with active polio transmission resume vaccination activities as soon as it is safe to do so, in line with WHO and national COVID-19 guidance. Burkina Faso and Angola were among the first countries to start implementing cVDPV outbreak response campaigns after the pause.

These campaigns are closely following safety guidelines and social distancing measures to protect communities and health workers against COVID-19. Measures including the use of masks and gloves, frequent handwashing and no-touch vaccination.

COVID-19 undoubtedly represents a setback for polio eradication, but not the first one the programme has faced. The GPEI and African countries’ national polio programmes are committed to ensuring that countries are ready to tackle the remaining challenge of cVDPVs and to recover lost ground once polio activities can safely ramp up.

Nurse Madelein Semo vaccinates a young baby with inactivated polio vaccine (IPV) at the Ngbaka health centre in Kinshasa, Democratic Republic of the Congo, on April 29, 2015. Gavi’s support for IPV represents the insurance policy for the success of the Polio Endgame Strategy. ©GAVI/2015/Phil Moore

On 4 June 2020, the UK Government hosted Gavi’s third donor pledging conference, the Global Vaccine Summit, to mobilize at least US$ 7.4 billion to protect the next generation with vaccines, reduce disease inequality and create a healthier, safer and more prosperous world. Responding to this unique call for global solidarity, leaders from donor countries and the private sector made unprecedented commitments of US$ 8.8 billion in order to save up to 8 million lives.

Since 2019, the Global Polio Eradication Initiative (GPEI) has strengthened its collaboration with Gavi, inviting Gavi to become the sixth core partner of the GPEI. While the GPEI will continue its focus on interrupting virus transmission and eradicating polio through immunization campaigns using the oral polio vaccine (OPV), Gavi’s support for the inactivated polio vaccine (IPV) at an estimated cost of US$ 800 million during its 2021-25 strategic period represents the insurance policy for the success of the Polio Endgame Strategy.

Thanks to the remarkable mobilization and solidarity of leaders worldwide, Gavi will be able to maintain immunization in developing countries, mitigating the impact of the COVID-19 pandemic. Gavi will also be able to sustain health systems so that countries are ready to rapidly introduce COVID-19 vaccines. And by 2025 Gavi will have immunized more than 1.1 billion children, saving 22 million lives. Ngozi Okonjo-Iweala, Chair of the Gavi Board, highlighted why this is so important, saying, “Vaccinations should be recognized as a global public good. With your support and commitment, we can generate US$ 70 to US$ 80 billion additional economic benefits.”

Henrietta Fore, Executive Director of UNICEF, added, “We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another.” UN Secretary-General Antonio Guterres urged partners to “find safe ways to continue to deliver vaccinations during COVID-19.” GPEI, Gavi, WHO and UNICEF have issued guidance for countries to encourage resuming immunization activities once it is safe to do so, in recognition of the fact that numerous countries are facing COVID-19 and multiple other disease outbreaks.

During the Summit, top Gavi donors reaffirmed their leadership, including Norway, the UK and the USA, as well as the Bill & Melinda Gates Foundation. Prime Minister Boris Johnson pledged £1.65 billion, recommitting the UK as Gavi’s leading donor while the Gates Foundation committed US$ 1.6 billion. More than 60 leaders from all regions of the world in the Asia-Pacific, Middle East, Africa, Europe and the Americas pledged support to Gavi, the Vaccine Alliance both for its upcoming strategic period as well as for COVID-19 response.

The COVID-19 pandemic reminds us of the power of vaccines. WHO Director-General Tedros Adhanom noted, “COVID-19 is a devastating reminder that life is fragile, and that in our global village our individual health depends on our collective health. … Now is the moment for the world to come together in solidarity to realise the power of vaccines for everyone.” Responding to this challenge, Gavi has launched the Gavi Advance Market Commitment for COVID-19 (Gavi Covax AMC), which aims to raise additional funding in late June under the leadership of the European Union. Bill Gates, noted, “We would have to create Gavi if it did not exist today to solve the COVID-19 crisis.”

Michel Zaffran, director of the WHO polio eradication programme, said, “Congratulations to the Gavi family for this exemplary mobilization and demonstration of global solidarity. We are immensely grateful to Gavi and its donors for their precious partnership and generous support for the inactivated polio vaccine (IPV). The COVID-19 pandemic is a terrible tragedy, which brings us together more than ever and requires to think collectively how best to address the needs of the communities.”

Rotary, one of the six GPEI partners, echoed statements from other agencies. “Rotary and its members applaud the commitment of the donors and governments who have pledged their support to ensuring that vulnerable communities can receive lifesaving vaccinations,” said Michael K. McGovern, Polio Oversight Board and Chair of Rotary’s International PolioPlus Committee. “Continued investment from the global community in programmes such as the Global Polio Eradication Initiative is crucial to not only achieving the eradication of polio, but ensuring stronger health systems worldwide. This firm commitment truly embodies the “Plus” in PolioPlus.”

While the Global Vaccine Summit secured the IPV requirements for polio eradication efforts through 2025, further financial commitment is needed for the GPEI to restart the immunizations campaigns that have been paused during the COVID-19 pandemic. More intensive and integrated immunization activities are needed to finish the job and to strengthen the capacities of the governments, health workers and networks, so that the investment in polio eradication can serve as a foundation for future pandemic response. While celebrating the success of the Global Vaccine Summit, GPEI calls for reiterated donor support to eradicate polio once and for all.

Tahira and daughter Dua attend a routine immunization session in Punjab province, Pakistan in January 2018. It is critical that immunization delivery systems are sustained through the COVID-19 pandemic. ©WHO Pakistan/Asad Zaidi

This month, world leaders have joined together to make several important commitments to strengthening public health infrastructure during the COVID-19 response – investments that will go a long way in protecting the most vulnerable communities, including those affected by polio.

On 4 May 2020, heads of government, institutions and industry pledged USD $7.4 billion (of the USD $8 billion goal) to ensure equitable access to new tools for COVID-19 globally. The funding will support the Access to COVID-19 Tools Accelerator, which will help develop new global health technology solutions to test, treat and protect people, and prevent the disease from spreading.

A day later, several donors pledged new funding to Gavi, one of the partners of the Global Polio Eradication Initiative (GPEI), ahead of its upcoming replenishment in June 2020. This funding will not only help vaccinate hundreds of millions of children against diseases such as polio, but also ensure that immunization delivery systems are sustained through the pandemic.

The GPEI greatly appreciates outstanding donor community support for both the COVID-19 response effort and routine immunization programmes around the world.

The GPEI is continuing to do its part to support the COVID-19 pandemic, in solidarity with other health initiatives. In March, the Polio Oversight Board made the recommendation to pause polio vaccination campaigns to limit further spread of the disease. Countries extended their key polio eradication assets, like infrastructure and human resources, to support countries’ COVID-19 response efforts, while continuing essential activities. As of May, GPEI resources, including surveillance laboratories, and social mobilization and communication networks, are supporting COVID-19 response in at least 55 countries.

The pause of vaccination campaigns and the disruption of routine immunization services leaves millions of children at high risk of contracting polio, measles and other vaccine preventable diseases (VPDs). The COVID-19 pandemic has demonstrated that vaccines, against both COVID-19 and VPDs, are crucial to protecting individuals, communities and economies.

As countries continue to implement their COVID-19 response plans, WHO and UNICEF are working with emergency and immunization partners to ensure the polio infrastructure not only supports the response, but also is fully funded in alignment with the ongoing efforts to finance COVID-19. While work is ongoing to cost those requirements, the GPEI hopes that specific COVID funds will be able to contribute towards its response efforts.

It is critical that essential health services and systems, including polio eradication efforts, have necessary support during both the response and recovery phases of this pandemic. While the GPEI has extended its assets to the global COVID-19 response effort, sustaining these programmatic resources is imperative. Continued donor commitments will enable the safe and effective resumption of polio vaccination campaigns as the situation evolves.

A polio worker administering the life-saving polio drops to children in Pakistan © WHO/EMRO

In the midst of the COVID-19 pandemic, it is more critical than ever to recognize the power and importance of vaccines, which save millions of lives each year. Canada, the first government to contribute to the global effort to eradicate polio in 1986, has announced new investments to support immunization. Alongside renewed funding for Gavi, the Vaccine Alliance, the Honourable Karina Gould, Canada’s Minister of International Development, committed C$ 47.5 million annually over four years to support the Global Polio Eradication Initiative’s Endgame Strategy.

Due to widespread polio vaccination efforts over the past 30 years, more than 18 million people are walking today who would otherwise have been paralyzed, and cases have dropped by 99.9% thanks to the tireless efforts of health workers, local governments and global partners. The GPEI is proud to count on generous donors, including Canada, who have helped make this progress possible. This new investment will help the programme ensure gains made to date are not lost, resume activities as soon as it is feasible, implement strategies to overcome the remaining barriers to eradication, and further the dream of a polio-free world.

Minister Gould stated: “As a global community, we must work to ensure that those most vulnerable, including women and children, have access to vaccinations to keep them healthy wherever they live. COVID-19 has demonstrated that viruses do not know borders. Our health here in Canada depends on the health of everyone, everywhere. Together, we must build a more resilient planet.” The Minister added “The world has never been closer to eradicating polio, but the job is not done. With continued transmission in Afghanistan and Pakistan, we cannot afford to be complacent.”

Frontline polio workers in countries around the world are currently supporting the COVID-19 response, using networks established by the GPEI to focus on case detection, tracing, testing and data management. The G7 and the G20, including the Canadian Government, have recognized the important role GPEI assets play in strengthening health systems and advancing global health security, especially among the most vulnerable populations of the world.

In line with its feminist international assistance policy, Canada has encouraged the GPEI to build on the important role played by women in the programme, from the front lines to programme management and political leadership.

Akhil Iyer, Director of the Polio Eradication Programme at UNICEF said, “The new funding from the Canadian government is a testament to the major role played by the Canadian people in the historical fight against polio, and I am proud to be part of this endeavour as a Canadian citizen myself. Back in the 1950’s in Canada, poliovirus outbreaks could have paralysed or killed so many more children, and could have plagued the economy and pushed millions in vicious circles of poverty and ill health. But thanks to the scientific breakthrough of Dr. Leone Farrell who made mass production of polio vaccines possible, strong leadership and a learning health system, Canada was able to overcome the polio outbreaks and thrive during the following decades. It is more inspiring than ever, as we strive together to end polio from the world for good.”

Rotary clubs throughout Canada welcomed the new pledge as a continuation of the country’s leadership and partnership to end polio. Canada has worked closely with Rotary clubs in Canada since 1986 when Canada became a donor to GPEI. To date, Canadian Rotarians have raised and contributed more than US$ 41.3 million to eradication efforts.

Michel Zaffran, Director of the Polio Eradication Programme at the World Health Organization said, “I would like to express the profound gratitude of the GPEI partners to the Government and to the citizens of Canada for their tremendous support and engagement to end polio globally. The pandemic we are facing today is a stark reminder of the critical need for solidarity at all levels, international cooperation and of the power of vaccines and immunization. Canada is walking the talk: it is demonstrating once more its exemplary commitment to ensuring access to essential vaccinations, leading efforts to advance gender equality and reducing the burden of infectious diseases.”

This week, the Global Polio Eradication Initiative (GPEI) celebrates World Immunization Week (WIW) alongside partners around the world who have worked tirelessly to protect children from vaccine-preventable diseases. Every year, the GPEI vaccinates more than 450 million children against polio in almost 50 countries. These efforts would not be possible without the dedication of vaccine champions – including health workers, parents, government leaders and donors – who are committed to sharing the message that #VaccinesWork for All.

This WIW comes at a difficult time as immunization campaigns – including polio campaigns – are being suspended around the world due to the threat of COVID-19. But, it’s also an important moment to acknowledge the incredible progress we’ve made against polio thanks to our generous donors. (Read more on how the GPEI is responding to the COVID-19 pandemic.)

During this WIW, we are grateful for the longstanding support and dedication of our partners, including His Highness Sheikh Mohamed bin Zayed Al Nahyan, the Crown Prince of Abu Dhabi. At the Reaching the Last Mile Forum in Abu Dhabi in November 2019, global leaders pledged US$2.6 billion to eradicate polio – including His Highness’s pledge of US$160 million, which comes on the heels of pledges dating back a decade. This support has, for example, allowed for the delivery of more than 400 million drops of polio vaccine to protect the most vulnerable and hard-to-reach children in Pakistan and funded more than 5,000 full-time vaccinators in high-risk areas of the country.

Further, through the UAE-Pakistan Assistance Program (UAE PAP), the UAE is helping to build healthy communities and protect against polio through poverty eradication – including by delivering food aid, building water treatment plants and leading infrastructure projects.

While WIW encourages us to celebrate the progress we’ve made and highlight that #VaccinesWork, it also reminds us that continued commitment is key to ending polio once and for all. When the COVID-19 emergency subsides, we will come back stronger and faster in our mission to reach every child with the polio vaccine. These efforts are only made possible by our valued donors. This WIW, we are thankful to UAE leadership for their continued support in our efforts to #EndPolio.

Reposted with permission from Rotary.org.

Isiaku Musa Maaji, a polio survivor himself, makes a living by building tricycles for people with mobility impairments. © Rotary International

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The ‘plus’ is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap.

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases, and in part two we investigated how Rotary contributes to clean water provision. In our final article, we consider how Rotarians support those who have contracted polio, and who now live with permanent paralysis.

Creating jobs

Polio paralysis left Isiaku Musa Maaji, who lives in Nigeria, with few ways to make a living. At 24, he learned to build hand-operated tricycles designed to provide mobility for adults and children with physical disabilities, and later started his own business assembling them. His first break came, he says, when his local government placed a trial order. Officials were impressed with his product, and the orders continued.

Rotary’s Nigeria PolioPlus Committee recently ordered 150 tricycles from Maaji to distribute to polio survivors and others with mobility problems. The relationship he has built with local Rotarians has motivated him to take part in door-to-door polio vaccination campaigns.

“It is not easy to be physically challenged,” he says. “I go out to educate other people on the importance of polio vaccine because I don’t want any other person to fall victim to polio.”

Aliyu Issah is now a strong advocate for polio immunization. © Rotary International

Aliyu Issah, another polio survivor, feels lucky; he’s able to support himself running a small convenience store. He knows others with polio paralysis who have attended skills training programmes but lacked the money to start a similar business. In the absence of ready employment, some of them were forced to beg on the street.

He notes however that the polio eradication programme provides a job that is uniquely suited to polio survivors: educating others about the effects of the disease.

“Some of my friends who used to be street beggars now run their own small business with money they earn from working on the door-to-door immunization campaign,” Issah says.

Improving health care

In Maiduguri, Nigeria, Falmata Mustapha rides a hand-operated tricycle donated to her by Rotary’s Nigeria PolioPlus Committee. She is joined by several health workers for a door-to-door immunization campaign, bringing polio drops to areas without basic health care.

Falmata Mustapha uses her hand-operated tricycle for door-to-door campaigns. ©Rotary International

UNICEF data show that polio survivors like Mustapha have a remarkable success rate persuading reluctant parents to vaccinate their children — on average, survivors convince seven of every ten parents they talk to. In places where misinformation and rumours have left people hesitant to vaccinate, the survivors’ role in the final phase of the eradication effort is critical.

“Since working with the team, I have seen an increase in immunization compliance in the community,” Mustapha says. “I am well-regarded in the community because of my work, and I am happy about this.”

Three-year-old Madsa is carried by her sister after receiving a polio vaccine during a door-to-door campaign in Maroua, Cameroon. ©Gates Archive/Dominique Catton

ABU DHABI, 19 November 2019 – Today, global leaders convened at the Reaching the Last Mile (RLM) Forum in Abu Dhabi to affirm their commitment to eradicate polio and pledge US$2.6 billion as part of the first phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.

This pledging event comes on the heels of a major announcement last month that the world has eradicated two of the three wild poliovirus strains, leaving only wild poliovirus type 1 (WPV1) still in circulation. Additionally, Nigeria – the last country in Africa to have cases of wild polio – has not seen wild polio since 2016 and the entire WHO African region could be certified wild polio-free in 2020. Thanks to the dedicated efforts of health workers, governments, donors and partners, wild polio only circulates in two countries: Pakistan and Afghanistan.

“From supporting one of the world’s largest health workforces, to reaching every last child with vaccines, the Global Polio Eradication Initiative is not only moving us closer to a polio-free world, it’s also building essential health infrastructure to address a range of other health needs,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Polio Oversight Board. “We are grateful for the generous pledges made today and thank governments, donors and partners for standing with us. In particular, I would like to thank His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi for hosting the GPEI pledging moment and for his long-term support for polio eradication.”

The commitments announced today come at a critical time for the polio eradication effort. Barriers to reaching every child – including inconsistent campaign quality, insecurity, conflict, massive mobile populations, and, in some instances, parental refusal to the vaccine – have led to ongoing transmission of the wild poliovirus in Pakistan and Afghanistan. Further, low immunity to the virus in parts of Africa and Asia where not all children are vaccinated has sparked outbreaks of a rare form of the virus. To surmount these obstacles and protect 450 million children from polio every year, governments and donors announced significant new financial commitments toward the $3.27 billion needed to support the Polio Endgame Strategy.

Pledges are from a diverse array of donors, including: US$160 million from the host of the pledging moment His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi; countries, including US$215.92 million from the United States, US$160 million from the Islamic Republic of Pakistan, US$105.05 million from Germany, US$84.17 million from the Federal Government of Nigeria, US$10.83 million from Norway, US$10.29 million from Australia, US$7.4 million from Japan, US$2.22 million from Luxembourg, US$1.34 million from New Zealand, US$116,000 from Spain, and US$10,000 from Liechtenstein; GPEI partners, including US$1.08 billion from the Bill & Melinda Gates Foundation and US$150 million from Rotary International; philanthropic organizations, including US$50 million from Bloomberg Philanthropies, US$25 million from Dalio Philanthropies, US$15 million from the Tahir Foundation, US$6.4 million from the United Nations Foundation, US$2 million from Alwaleed Philanthropies, US$1 million from the Charina Endowment Fund, and US$1 million from Ningxia Yanbao Charity Foundation; and the private sector, including US$1 million from Ahmed Al Abdulla Group, US$1 million from Al Ansari Exchange, and US$340,000 from Kasta Technologies. Earlier this month, the United Kingdom announced it would contribute up to US$514.8 million to the GPEI.

“We are proud to host the GPEI pledging moment in Abu Dhabi and thank all the attendees for their continued commitment to the eradication of polio,” said Her Excellency Reem Al Hashimy, UAE Cabinet Member and Minister of State for International Cooperation. “Since launching in 2014, the Emirates Polio Campaign has delivered more than 430 million polio vaccines in some of the most remote areas of Pakistan. We remain firm in our mission to reach every last child and believe together we can consign polio to the pages of history.”

In addition to overcoming barriers to reach every child, this funding will ensure the resources and infrastructure built by the GPEI can support other health needs today and in the future. Polio workers deliver Vitamin A supplements, provide other vaccines like those for measles and yellow fever, counsel new mothers on breastfeeding, and strengthen disease surveillance systems to anticipate and respond to outbreaks. As part of its commitment to advance gender equality and women’s empowerment, the GPEI is also working to ensure equal participation of women at all levels of the programme.

The future of polio eradication hinges on support and engagement at all levels of the programme – from individuals to communities to local and national governments to donors. If the strategies needed to reach and vaccinate children are fully implemented and funded, we are confident that we can deliver a world where no child lives in fear of polio.

Pledge values are expressed in US dollars. View the full list of donors and pledge amounts.

Media contacts:

Oliver Rosenbauer

Communications Officer, World Health Organization

Email: rosenbauero@who.int

Tel: +41 79 500 6536

John Butler

Vice President, Global Health Strategies

Email: jbutler@globalhealthstrategies.com

Tel: +44 7502 203498

Reposted with permission from Rotary.org.

Women and children collect water from a borehole in the Madinatu settlement, where about 5000 displaced people live. © Rotary International

This series looks at the ‘pluses’ that Rotarians worldwide help to provide. Our first article looked at prevention of other diseases. In part two, we look at another lifechanging intervention: providing clean water for communities.

Providing clean water

Addressing a critical long-term need such as access to clean water helps build relationships and trust with community members. Within camps for displaced people in northern Nigeria, the polio vaccinators who regularly visit communities are sometimes met with frustration. “People say, ‘We don’t have water, and you’re giving us polio drops,’” Tunji Funsho explains. Rotary and its partners have responded by funding 31 solar-powered boreholes to provide clean water in northern Nigeria, and the effort is ongoing.

Supplying clean water to vulnerable communities is a priority of the PolioPlus programme not only in Nigeria, but also in Afghanistan and Pakistan — the only other remaining polio-endemic nations, where transmission of the virus has never been interrupted.

Water, Sanitation, and Hygiene (WASH) and polio eradication efforts go together. © Rotary International

“Giving water is noble work also,” says Aziz Memon, chair of Rotary’s Pakistan PolioPlus Committee.

Access to safe drinking water is also an important aspect of the The Polio Endgame Strategy 2019-2023, which aims to “ensure populations reached for polio campaigns are also able to access much-needed basic services, such as clean water, sanitation, and nutrition.” The poliovirus spreads through human waste, so making sure people aren’t drinking or bathing in contaminated water is critical to eradicating the disease. Bunmi Lagunju, the PolioPlus project coordinator in Nigeria, says that installing the boreholes has helped prevent the spread of cholera and other diseases in the displaced persons camps.

Communities with a reliable source of clean water have a reduced rate of disease and a better quality of life. “When we came [to the camp], there was no borehole. We had to go to the nearby block factory to get water, and this was difficult because the factory only gave us limited amounts of water,” says Jumai Alhassan, as she gives her child a bucket-bath. “We are thankful for people who provided us with the water.”

By looking holistically at the needs of communities, Rotarians are ending polio, and making a significant contribution to overall health.

This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine. Read part one.

The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.

Seven-month-old Abdihakim Osman receives double doses of the oral polio vaccine during a national immunization campaign in Hargeisa, Somaliland. G20 members are some of the most committed supporters of polio eradication efforts. ©WHO/Ilyas Ahmed

G20 Health Ministers met in Okayama, Japan, on 19 and 20 October 2019 to address major global health issues in order to pave the way towards a more inclusive and sustainable world, as envisioned in the 2030 Agenda for Sustainable Development.

Ministers put a strong emphasis on ending polio in the resulting declaration, reaffirming their “commitment to eradicate polio”, and recognizing the remaining challenges.

Ministers welcomed next month’s pledging event. With the support of G20 members and other important global donors, the Global Polio Eradication Initiative aims to successfully raise funds to overcome the remaining challenges that face the world as we work to end polio. The pledging event will be generously hosted by the UAE and His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, as part of the Reaching the Last Mile Forum on 19 November 2019, and intends to secure the financial commitments needed for the programme to finish the job.

Ministers noted, “We are concerned with the rising number of vaccine-derived polio outbreaks. We call for a strong cross-border cooperation and strict implementation of vaccine requirements for travelers as specified in the International Health Regulations (IHR, 2005).”

The polio programme is currently responding to vaccine-derived poliovirus outbreaks in 18 countries. The encouragements of the G20 Health Ministers regarding the pledging event, IHR implementation and cross-border collaboration are welcomed as part of measures to ensure high quality comprehensive outbreak response and the ability of the programme to eradicate the virus.

In addition, Ministers expressed support for “the efforts of the Global Polio Eradication Initiative (GPEI), Gavi, the Vaccine Alliance (Gavi), WHO, UNICEF, and other stakeholders in strengthening routine and supplemental immunization,” and highlighted the “leadership role of WHO”. This year, Gavi has joined the Polio Oversight Board, becoming the sixth partner of the initiative. Ministers referred to the importance of “the transition of relevant polio assets” to other health programmes, a process that will be strengthened by Gavi’s partnership.

Polio eradication has an important role to play in the implementation of other global health goals. Considering this broader context, Ministers recognized that “high quality and safe primary health care including access to vaccination is a cornerstone for UHC”. Ministers noted, “We recognize that immunization is one of the most cost-effective health investments with proven strategies that make it accessible to all segments of the population with an emphasis on women and girls, the most hard-to-reach as well as the vulnerable and marginalized populations. We express our concern about vaccine hesitancy as mentioned in the WHO’s Ten threats to global health in 2019.”

Vaccination is the only way to eradicate polio and the GPEI is working tirelessly in some of the most challenging contexts to ensure all children, boys and girls, regardless of where they live, have access to life-saving vaccines.

This important statement from G20 Ministers of Health represents a continuation of the strong historical political support for polio eradication from both the G7 and the G20, at the highest levels.

The statement also follows the reaffirmation of support for polio eradication by G20 health leaders during their June 2019 summit. In this meeting, they discussed major challenges facing the world and once more communicated that “we reaffirm our commitment to eradicate polio”.

In 2020, Saudi Arabia will hold the presidency of the G20 and the US Government will hold the Presidency of the G7.

The Government of Japan, current host of the G20, is committed to the eradication of polio, providing US$ 563 million in grants to the GPEI since 1988.

Read the Okayama Declaration of the G20 Health Ministers.

Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presenting the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. ©WHO

25 October 2019, Geneva, Switzerland

My fellow Polio Eradicators,

Yesterday was World Polio Day, a global awareness-raising day on the need to complete the job of polio eradication, and here at the World Health Organization (WHO) headquarters, it was my great honour to make a truly phenomenal announcement: that wild poliovirus type 3 has been certified as globally eradicated, by the Global Commission for the Certification of Poliomyelitis Eradication.

This is the second of the three types of wild poliovirus to have been globally eradicated. Only wild poliovirus type 1 remains in circulation, in just two countries worldwide. Africa has not detected any wild poliovirus of any type since September 2016, and the entire African Region is eligible to be certified free of all wild poliovirus next June.

Global wild poliovirus type 3 eradication is a tremendous achievement and is an important milestone on the road to eradicate all poliovirus strains. This shows us that the tactics are working, as individual family lines of the virus are being successfully knocked out.

But the job is not finished until ALL strains of poliovirus are fully eradicated – and stay eradicated. We must achieve final success or face the consequences of renewed global resurgence of this ancient scourge. We must eradicate the remaining strains of WPV1 and also address the increasing circulating vaccine-derived poliovirus outbreaks, in particular in Africa.

And here too we are making strong inroads. New strategies are helping us reach the most vulnerable populations, particularly in the remaining reservoir areas. New tools, including a brand-new vaccine, are being developed, to ensure the long-term risk of vaccine-derived polioviruses can be comprehensively addressed.

But these tools and tactics only work if they are fully funded, and fully implemented.

And so today, on the day after this tremendous announcement, I really have two messages for you.

The first is a simple and whole-hearted ‘thank you’. Thank you for making a world free of wild poliovirus type 3 a reality. Thank you to all countries, to all donors, to all stakeholders, partners, advisory and oversight groups, policy makers, Rotarians. Most importantly, thank you to all communities, to all parents. To all frontline health workers. They are the real heroes of this achievement.

And my second message is: please do not stop now. The Reaching the Last Mile Forum, hosted in the United Arab Emirates this November by His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, will provide an opportunity for many of our stakeholders to recommit their efforts to a polio-free world. I urge all of you to stay committed and redouble determination in this final push to the finish line.

Together, the partners of the Global Polio Eradication Initiative (GPEI) – WHO, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance – stand ready to support this global effort. But it will take collective and global collaboration, from all public- and private-sector stakeholders, to ensure every last child is reached and protected from all polioviruses.

Together, let us achieve history: let us ensure that no child anywhere will ever again by paralysed by any poliovirus.

Thank you.

Dr Tedros Ghebreyesus

Chair, GPEI Polio Oversight Board

Director-General, WHO

Children showing off their marked fingers after vaccination. ©WHO/Sigrun Roesel

24 October 2019 – In a historic announcement on World Polio Day, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. Following the eradication of smallpox and wild poliovirus type 2, this news represents a historic achievement for humanity.

“The achievement of polio eradication will be a milestone for global health. Commitment from partners and countries, coupled with innovation, means of the three wild polio serotypes, only type one remains,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization and Chair of the Global Polio Eradication Initiative (GPEI) Polio Oversight Board “We remain fully committed to ensuring that all necessary resources are made available to eradicate all poliovirus strains. We urge all our other stakeholders and partners to also stay the course until final success is achieved,” he added.

There are three individual and immunologically-distinct wild poliovirus strains: wild poliovirus type 1 (WPV1), wild poliovirus type 2 (WPV2) and wild poliovirus type 3 (WPV3). Symptomatically, all three strains are identical, in that they cause irreversible paralysis or even death. But there are genetic and virologic differences which make these three strains three separate viruses that must each be eradicated individually.

WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Since then, the strength and reach of the eradication programme’s global surveillance system has been critical to verify that this strain is truly gone. Investments in skilled workers, innovative tools and a global network of laboratories have helped determine that no WPV3 exists anywhere in the world, apart from specimens locked in secure containment.

At a celebration event at the headquarters of the World Health Organization in Geneva, Switzerland, Professor David Salisbury, chair of the independent Global Commission for the Certification of Poliomyelitis Eradication, presented the official certificate of WPV3 eradication to Dr Adhanom Ghebreyesus. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury. “This this is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1. This virus remains in circulation in just two countries: Afghanistan and Pakistan. We cannot stop our efforts now: we must eradicate all remaining strains of all polioviruses. We do have good news from Africa: no wild poliovirus type 1 has been detected anywhere on the continent since 2016 in the face of ever improving surveillance. Although the region is affected by circulating vaccine-derived polioviruses, which must urgently be stopped, it does appear as if the continent is free of all wild polioviruses, a tremendous achievement.”

Eradicating WPV3 proves that a polio-free world is achievable. Key to success will be the ongoing commitment of the international development community. To this effect, as part of a Global Health Week in Abu Dhabi, United Arab Emirates, in November 2019, the Reaching the Last Mile Forum will focus international attention on eradication of the world’s deadliest diseases and provide an opportunity for world leaders and civil society organizations, notably Rotary International which is at the origin of this effort, to contribute to the last mile of polio eradication. The GPEI 2019–2023 Investment Case lays out the impact of investing in polio eradication. The polio eradication efforts have saved the world more than US$27 billion in health costs since 1988. A sustained polio-free world will generate further US$14 billion in savings by 2050, compared to the cost countries would incur for controlling the virus indefinitely.

The GPEI is a public-private global effort made up of national governments, partners including the World Health Organization, Rotary International, the US Centers for Disease Control and Prevention, UNICEF, the Bill & Melinda Gates Foundation and a broad range of long-term supporters.

Reposted with permission from Rotary.org

When we talk about PolioPlus, we know we are eradicating polio, but do we realize how many added benefits the programme brings? The “plus” is something else that is provided as a part of the polio eradication campaign. It might be a hand-operated tricycle or access to water. It might be additional medical treatment, bed nets, or soap. This series takes a look at the ‘Pluses’, starting with prevention of other diseases. A 2010 study estimates that vitamin A drops given to children at the same time as the polio vaccine had at that time already prevented 1.25 million deaths by decreasing susceptibility to infectious diseases.

We take you to Nigeria, which could soon be declared free of wild poliovirus, to show you some of the many ways the polio eradication campaign is improving lives.

Health workers in Maiduguri, Borno State, tallying vaccine count. ©Rotary International

Polio vaccination campaigns are difficult to carry out in northern Nigeria, where insurgency has displaced millions of people, leading to malnutrition and spikes in disease. When security allows, health workers diligently work to bring the polio vaccine and other health services to every child, including going tent to tent in camps for displaced people.

The Global Polio Eradication Initiative (GPEI), of which Rotary is a spearheading partner, funds 91% of all immunization staff in the World Health Organization’s Africa region. These staff members are key figures in the fight against polio — and other diseases: 85% give half their time to immunization, surveillance, and outbreak response for other initiatives. For example, health workers in Borno use the polio surveillance system, which detects new cases of polio and determines where and how they originated, to find people with symptoms of yellow fever. During a 2018 yellow fever outbreak, this was one of many strategies that resulted in the vaccination of 8 million people. And during an outbreak of Ebola in Nigeria in 2014, health workers prevented that disease from spreading beyond 19 reported cases by using methods developed for the polio eradication campaign to find anyone who might have come in contact with an infected person.

Hurera Idris is installing insecticide-treated bed nets in her home. ©Rotary International

Children protected from polio still face other illnesses. In Borno, malaria kills more people than all other diseases combined. To prevent its spread, insecticide-treated bed nets — such as the one Hurera Idris is pictured installing in her home above — are often distributed for free during polio immunization events. In 2017, the World Health Organization organized a campaign to deliver antimalarial medicines to children in Borno using polio eradication staff and infrastructure. It was the first time that antimalarial medicines were delivered on a large scale alongside the polio vaccine, and the effort reached 1.2 million children.

Rotary and its partners also distribute soap and organize health camps to treat other conditions. “The pluses vary from one area to another. Depending on the environment and what is seen as a need, we try to bridge the gap,” says Tunji Funsho, chair of Rotary’s Nigeria PolioPlus Committee. “Part of the reason you get rejections when you immunize children is that we’ve been doing this for so long. In our part of the world, people look at things that are free and persistent with suspicion. When they know something else is coming, reluctant families will bring their children out to have them immunized.”

Rotarians’ contributions to PolioPlus help fund planning by technical experts, large-scale communication efforts to make people aware of the benefits of vaccinations, and support for volunteers who go door to door.

Fatima Umar, a volunteer, is educating Hadiza Zanna about health topics such as hygiene and maternal health, in addition to why polio vaccination is so important. ©Rotary International

Volunteer community mobilizers are a critical part of vaccination campaigns in Nigeria’s hardest-to-reach communities. The volunteers are selected and trained by UNICEF, one of Rotary’s partners in the GPEI, and then deployed in the community or displaced persons camp where they live. They take advantage of the time they spend connecting with community members about polio to talk about other strategies to improve their families’ health.

Nigerian Rotarians have been at the forefront of raising support for Rotary’s polio efforts. For example, Sir Emeka Offor, a member of the Rotary Club of Abuja Ministers Hill, and his foundation collaborated with Rotary and UNICEF to produce an audiobook called Yes to Health, No to Polio that health workers use.

This story is part of the Broader Benefits of Polio Programme series on our website, which originally appeared in the October 2019 issue of The Rotarian magazine.

The polio eradication campaign needs your help to reach every child. Thanks to the Bill & Melinda Gates Foundation, your contribution will be tripled. To donate, visit endpolio.org/donate.

The Emirates Polio Campaign works with communities at risk for polio. Through coordinated efforts, the Campaign provides vaccines along with food aid, sanitation and infrastructure projects. © WHO — The Emirates Polio Campaign works with communities at risk for polio. Through coordinated efforts, the Campaign provides vaccines along with food aid, sanitation and infrastructure projects. Photo courtesy Reaching the Last Mile

On 9 September 2019, the Global Polio Eradication Initiative (GPEI) partners and the United Arab Emirates co-hosted an informal reception as a pre-event ahead of the Polio Pledging Moment in the United Arab Emirates’-hosted Reaching the Last Mile Forum in Abu Dhabi, in November 2019. The GPEI also presented the 2019-2023 GPEI Investment Case.

The reception brought together GPEI stakeholders including, Rotary International, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), representatives from the UAE; WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus; partners, and representatives from donor countries.

Following the GPEI Endgame Strategy 2019-2023, which spells-out a comprehensive five-year plan to ‘finish the job,’ the 2019-2023 Investment Case presents an economic case for investing in polio eradication as an important public health cause. Committing to eradication and achieving the goal of reaching every last child with the polio vaccine, an estimated US$ 14 billion are expected in cumulative cost savings by 2050, with efforts to eradicate polio having already saved more than US$27 billion since 1988. The need of the hour now is a bold financial and political commitment from leaders, donors, and governments around the world to rally behind a polio-free future.

As the GPEI launches its new investment case for 2019-2023, it recognizes important stakeholders who have gotten the programme to where it is today. One of the most notable donors is His Highness Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi.

His Highness Sheikh Mohamed bin Zayed has been a critical partner and champion of the GPEI. His support has helped spur significant progress toward stopping polio in the remaining endemic countries, with a specific focus on strengthening immunization efforts in Pakistan and Afghanistan. In 2018, the GPEI was proud to announce that His Highness’ support for polio eradication activities through the GPEI and the UAE Pakistan Assistance Programme and helped deliver 417 million vaccines to protect some of the most vulnerable and hard-to-reach children in the highest risk districts across the country.

WHO-DG and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus, sharing a candid moment with His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN). ©WHO

Starting off the reception, His Excellency Obaid Saleem Saeed Al Zaabi, UAE Permanent Representative to the United Nations (UN), gave insight into the UAE’s long-standing commitment to polio eradication efforts: “UAE, together with its partners, has played a leading role in polio eradication, has supported the delivery of vaccines to protect over 16 million children…and supported polio outbreak efforts in Afghanistan, Pakistan, Somalia, Ethiopia, Kenya and Sudan. For the implementation of the GPEI Endgame Strategy 2019-2023, which aims for a world free of wild poliovirus, the UAE in cooperation with the WHO will host a pledging event in Abu Dhabi in November 2019.”

WHO Director-General and Chair of the GPEI Polio Oversight Board, Dr Tedros Adhanom Ghebreyesus, also recognized the strong political and financial will of the donors —spanning over decades— which have helped the GPEI mark important milestones on the road to global polio eradication. “We have made good progress in accessing hard-to-reach communities…increasing cross-border efforts, enhancing surveillance, improving Supplementary Immunization Activities (SIAs), and focusing on social and behavioural change.”

“Unfortunately, we have seen an increase in the number of cases this year. This is a reminder that polio eradication is not a forgone conclusion…the last mile is the hardest. This will take a determined and unrelenting effort from all of us. Global progress to end polio would not be possible without partners like the UAE. On behalf of our partners at the GPEI, I would like to thank His Highness, Sheikh Mohammed bin Zayed Al Nahyan, Crown Prince of the Emirate of Abu Dhabi, and the UAE – a long-time supporter of the polio programme – for agreeing to host the GPEI pledging event on 19 November.”

Judith Diment, Chair of Rotary International Polio Eradication Advocacy Task Force, presenting the GPEI 2019-2023 Investment Case. © WHO

Rounding off the event, Chair of Rotary International Polio Eradication Advocacy Task Force, Judith Diment, officially presented the GPEI 2019-2023 Investment Case and called for concerted global efforts —both political and financial— to ensure that the hard-won gains in the fight against polio see us through the finish line. “Building on past progress and overcoming remaining hurdles requires continued support and (polio eradication) is a sound value-added investment. Today, we are proud to present the new 2019-2023 GPEI Investment Case…and thank all our partners for their input. This support and engagement are invaluable, given that this is a document that argues that polio can be eradicated but only with sufficient financial and political support. To ensure success, the Initiative needs US$ 3.27 billion through 2023… any investor is looking for measurable progress, tangible dividends, and return on investment— the GPEI has all of these. Rotary looks forward to joining all partners to make a funding pledge in Abu Dhabi, and to continued collaboration towards the fulfilment of a polio-free world from which we will all reap the dividends in perpetuity.”

The informal reception serves as a pre-event to the Reaching the Last Mile (RLM) Forum in November 2019, which will convene global health leaders to find solutions, best practices and eradication strategies to the most pressing health concerns of our times, including the global eradication of poliovirus. On the sidelines, the GPEI will also be hosting the Polio Pledging Moment to secure funding for the implementation of the Polio Endgame Strategy 2019-2023.